=====================================================
General NPI Number Information
=====================================================
NPI Number | 1023722345
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | DR. SHANNON LEDEL PICKETT-MILLS
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/11/2023
-----------------------------------------------------
Last Update Date | 01/11/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 100 MERRIMACK ST STE 205
-----------------------------------------------------
City | LOWELL
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 01852-1707
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 978-455-0756
-----------------------------------------------------
Fax | 978-455-0770
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 95 W SQUANTUM ST APT 1004
-----------------------------------------------------
City | QUINCY
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 02171-2111
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 334-462-6383
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 106H00000X
-----------------------------------------------------
Taxonomy Name | Marriage & Family Therapist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------